Monthly Archives: July 2006

It must be a year and a half now since I discovered Karen’s blog. I’ve already written about how I discovered Julie and her posse and got into the whole blogging thing, but Karen’s has always been one of my particular favourites. I’ve always been fascinated by adoption and what it involves as a way of building a family, and Karen’s experiences and reactions as she travelled that road made unforgettable reading.

When I started reading her blog, she was still working her way through the mindboggling amount of paperwork and bureaucracy that’s needed in order to get official approval to adopt a child. I went back through her archives and caught up on the story so far, and then I followed it avidly from that point onwards. I followed her blog as she finished the paperwork and passed the milestones of DTC and LID and planned her daughter’s nursery. I read about her doubts and about how she overcame them. I read about her experiences with some of the less tactful/more clueless section of the population, and how she dealt with those. I read about her grief at the knowledge that she would miss out on the first few months of her daughter’s life, and her desperate impatience to get her referral as soon as possible, not to miss any more. I read about what it was like to wait and wait and wait and wait and wait, inching closer and closer on a list where the referral rate was so arbitrary that it sometimes felt like taking one step back for every two steps forward. I read posts that must have been typed with fingers on which the nails were bitten to the bone.

And now, the day that Karen and I and hundreds of people across the Internet (and I’m not exaggerating about that – look at the comment threads) have been waiting for. Today is the day Karen gets her referral and finally finds out who her daughter is.

My grandmother is visiting from America and staying with us for the week, so we were out during the day (browsing round a nearby town and looking at the abbey), with me thinking about Karen, working out what time it must be in New York, wondering whether she’d slept at all and what she was doing. I logged on right after we got in and saw straight away that she still hadn’t got the call, and scrolled down and read her earlierposts from that day. Then I downloaded my e-mail and went and looked up something for someone who’d e-mailed me about something medically related, and came back about ten or fifteen minutes later and hit ‘Refresh’, and there was the post I’d been waiting for for so, so long.

Karen’s daughter has just turned one year old. Her Chinese name is Chao Xing, which means Morning Star. She is a beautiful, wonderful-sounding baby, and Karen will post her picture as soon as she’s collected it from the agency.

I feel as if the Internet just collectively let out a long-held breath. I can’t tell you how over the moon I am for Karen. I keep wiping away tears from my eyes every time I read her posts.

(And now – hurry up and get here, Little E! I can’t wait to hear more about you, as well!)

The-blogger-formerly-known-as-Magpie and I finally got around to meeting up again, having enjoyed the last time so much that it took us a mere four and a half months to get around to doing it a second time. Jamie and Little-E-to-be had obviously better learn to use phones and issue invites for themselves at an early stage if they want to have any hope of a decent social life.

J. confused me completely by changing her hair colour in the interim, thereby completely overloading my limited facial recognition abilities, but fortunately she recognised me and I’ve now warned her that she’ll need to wear a nametag if she makes a habit of this. We once again had an excellent time chatting away over our slices of cake while Jamie played with the toys, climbed on the tables, and pointed excitedly at the dog and the balloon outside the café doors. J. was highly complimentary about Jamie’s exceeding cuteness, his climbing ability, and his ability to sign ‘more’ (both of the latter being particularly pronounced when there was a chocolate brownie of Mummy’s to be pursued).

I’d hoped that she’d have some news on Little E. by this time, but apparently the next lot of referrals has now been postponed for another couple of weeks. Whether she’ll be in that batch or not is anyone’s guess, since the referral rumours currently appear to be emerging from a random number generator, but referrals have now happened up until less than a month before her LID, and if it isn’t this batch then surely, surely, it’s got to be the next one. Which means that, maybe, the next time we meet up we’ll be able to talk about her daughter as well, in more than just the abstract. Actually, given the length of time it’s likely to take us to get round to meeting up again, I’d say we can be pretty darned sure of it.

As I mentioned, Jamie says "Dada", but not "Mum". Or, to be more precise, he does say it, but he doesn’t use it to mean "Mummy" – it’s one of his variations on "milk". He clearly knows what "Mummy" means when someone else says it, but it doesn’t seem to have occurred to him to put it together with the sound that he knows how to make and use that sound meaningfully – the part of his brain that translates the speech he understands into spoken speech just doesn’t seem to have kicked in yet. I haven’t bothered teaching him a sign for the word – his enormous smile when he sees me is enough of a sign for me – but I’m looking forward to the day when he learns to say it. After all, that’s one of the more heartwarming moments in motherhood.

In the meantime, Jamie has his own way of getting his point across.

Today, we were once again investigating the whereabouts of Spot. He turned out to be in the basket as usual (oh, dear, I hope that wasn’t a spoiler – don’t let your toddlers read this) and I pointed at him and told Jamie "Look, there’s the little dog! And there," I added, pointing to his mother, "is the mummy dog."

With the gigantic smile that signals his delight at having put together something in a book with something in real life, Jamie pointed straight at me.

It took me a moment for this to click – I was sitting on the dusty concrete beside the pushchair in the yard at B&Q while Barry looked for gateposts, and the intricacies of the Spot hunt and its eventual conclusion were taking up only part of my mind. But then, I agreed delightedly with him that, yes, indeed, he was quite right – just as that dog was Spot’s mummy, I was Jamie’s mummy.

Barry returned and we headed off to a different part of B&Q in the continued search for gateposts, and I settled down next to Jamie’s pushchair to read him the book again. This time, when we reached that page, he pointed firmly back and forth between the mummy dog and me. Then he twisted round in his pushchair straps and flung his arm around me and hugged me. And I hugged him back and assured him that, yes, I was indeed his mummy, and I was very pleased indeed to be mummy to such a wonderful little boy.

When I brought theCIO debateover here from Hathor’s site, I hoped other people would also be willing to come over and continue, but resigned myself to the fact that everyone else would probably have got bored and moved on to the next thing – after all, I’d taken my usual sweet time about actually getting my post up. However, fortunately, Heather from Tucson has been patient enough to keep checking, and she’s now responded. Thank you.

I do, as a matter of fact, believe if I have a problem in the middle of
the night that my dear husband should get up and help me deal with it,
just as I do for him. Whether it be a nightmare, cramp, or what not. I
believe that that is what it mean to be married to someone.

I believe that being married to someone means that you take their needs, and their wishes, into account as well as your own; and you find a balance as best as you can. My husband has a need to sleep, as well as some other things he needs to do during the day (most of which are actually for the ultimate benefit of me and Jamie as well as himself). Sometimes my needs will take precedence over that and I’ll have to interrupt what he’s doing. But that doesn’t mean that everything I want, no matter how large or small it is, should take precedence over his needs.

I believe that the same sort of balancing act goes on between parents and children. I believe that if children need something in the middle of the night – a drink of water, a clean nappy, comfort – they ought to get it. If it’s just that they want company or want playtime or want someone to rock them because they find it easier to go back to sleep that way, then sometimes Mummy’s and Daddy’s needs are going to be more important than Baby’s wants.

Plus why is it that two adults can sleep together all night long, but a baby gets the boot?

Some people seem to see this as all one debate – CIO vs. co-sleeping, as though those were the only two ways that a parent would ever be dealing with a child’s sleep issues and the question is about which you should choose. It’s typical of the way that mummy debates get polarised into The Right Way and The Wrong Way. In actual fact, of course, it’s nothing like that simple – some families do neither CIO nor co-sleeping, some do both at different times or at different stages. The question of whether or not to co-sleep obviously has some overlap with the question of whether or not to do CIO, but it certainly isn’t just the same question phrased in a different form.

In our case, for example, ‘all night long’ was never the issue. Whenever Jamie woke up during the night, I took him into bed with us and we both went back to sleep – simple and straightforward. What this totally failed to solve was the problem of how to manage the evenings before we went to bed. This was the time of day when Jamie needed to sleep, even though he still wanted to play; when I needed dinner; and when Barry needed some adult company and conversation after a day looking after a toddler. Eventually, after trying various other ways of dealing with the situation with various degrees of success, we used a version of CIO, and that was what worked beautifully for all of us. And we went on co-sleeping during the night until Jamie started sleeping through the night several months later. In fact, since his cot is still in our room a few feet away from our bed, I believe we’re still co-sleeping, if I’m remembering the Official Attachment Parenting Definition correctly.

And you never answered my question reguarding what would you like to be
done to you if you were a helpless adult.

I did, in fact – you just didn’t want to accept my answer. If somebody had to look after me 24/7, I’d want them to get whatever breaks they needed to recharge and be physically and emotionally able to keep going. Even if that meant I didn’t always get company when I wanted it, that would still be better, long-term, then being looked after by a carer who was so exhausted and burnt out that he or she had become resentful and just couldn’t be that caring any more.

The difference, of course, is that I’d be able to recognise how important this was and a baby can’t. But that doesn’t mean it’s any less important to the baby, as well as the mother.

Would you really want to be
left alone, all night??

I doubt if I’d notice – after all, I’m usually asleep. I suppose it’s possible that I might have insomnia one night and want company, but I wouldn’t expect someone to wake up purely for that reason. But as for going to sleep at the beginning of the night, I usually do prefer being alone for that. It’s a time when I like to get a bit of space and think my own thoughts. Having someone else there trying to put me to sleep would probably just keep me awake. I can understand why the same seems to be true for at least some babies, and why, for those babies (not for all babies), sleep training actually seems to work better than the ‘gentle’ methods.

Magpie (who is now going under the identity of J, but I’m used to Magpie – maybe I should refer to her as the blogger formerly known as Magpie) has been asking about teaching babies to sign. Personally, I’m all in favour of it – not only is it one of the few areas in parenthood where there’s actually evidence of a particular benefit in doing things this way, but it’s also both useful and fun.

While signing was always on my list of things that sounded like good ideas to try with a baby, I was slow to get going with it, due to a mixture of my innate lack of organisation and some practical problems. First I figured it wasn’t a priority in his first few months of life, then I got distracted by the minor matter of moving half way across the country. Then, when I tried going to a local babysigning class, I drove twenty-five miles to the venue on the day Jamie picked to decide he DIDN’T WANT TO BE IN THIS CAR SEAT, DAMN YOU, only to find that the organisers hadn’t considered it important to state on their website that the class had split up for the holidays by that stage. This put me off the whole endeavour somewhat.

I did think about getting a book on the subject, but the books I saw on it all seemed to be ASL (American Sign Language) rather than BSL (British… oh, you get the picture). I do feel quite strongly that babies who are taught sign language ought to be taught the sign language of their own country. Of course, this argument didn’t work too well given that I wasn’t teaching Jamie any sign language, but tracking down a source from which I could learn some BSL signs was on my mental list of Things I Will Get Around To Doing Any Day Soon, so, of course, I didn’t do it and didn’t learn the ASL either. I did eventually manage to learn a few useful signs such as ‘eat’ and ‘drink’ and tried teaching him those, but he didn’t seem too interested. As time went on, I faced the fact that I’d missed the stage where all the books said that signing was particularly useful – the last few months of the first year, when comprehension is so far ahead of spoken language abilities. Jamie had reached the age where I could expect him to start talking any day now, and signing no longer really seemed worth it. I shrugged my shoulders and assigned signing to my mental list of things I’d do differently with the next baby.

Jamie did indeed start talking. Unfortunately, starting was all he did. Within vague sight of the textbook-dubbed time, he began using "muh-muh-muh" to mean "milk", and then, gradually, "da-da" to mean "Daddy". Then he decided that that was enough for now and no further comment on any situation would be necessary. In fact, for a while we ran into a Marklar situation, when Jamie decided that since waving his hands and yelling "Muh" got him milk when he wanted it, he should try this strategy for getting anything else he wanted as well. This limited the usefulness of the word somewhat, thereby cutting his practical use of language by a full fifty per cent.

Incidentally, I spent quite a bit of time worrying about whether I should be worrying about this. Jamie seemed to be doing all the other things he should be doing – taking his first steps, exploring everything, indulging in what is grandly called "interactive play" (blowing raspberries at Mummy and then screaming with laughter when Mummy blew raspberries back at him) – and my general feeling was that he was a perfectly normal little boy who would start talking in his own good time but whose own good time happened to differ somewhat from the textbooks’ own good time. However, not having been a mother long enough to feel totally confident that I could tell maternal intuition from wishful thinking, I worried about whether I was getting this totally wrong and missing early signs of some sort of disability that I should be moving heaven and earth to get him seen and treated for, the way all the heroic mothers did in the books. On the other hand, I didn’t want to be Paranoid Neurotic Mother either, and if I kicked up a fuss and got him seen by a specialist only to discover that he actually was as normal as I thought he was, I was going to feel pretty darned stupid.

Having thus spent some time vacillating in no-win land while sneaking peeks at every "By the age of X months you can reasonably expect your child to be doing… Some children with early signs of genius may be doing…. Panic if your child is not yet doing…." table that I could find, I did eventually manage to take him round for the weekly child-weighing at the local GPs, when one of my infrequent booked holidays actually coincided with the day the health visitor came round. This gave me the chance to mention my concerns casually to her in passing. She dismissed them just as casually (in her case, I think the casualness was genuine). Plenty of range in normality at this stage, she assured me, and if he seemed to be struggling when he was two we could rethink it then.

While I know this is the scene that shows up in Chapter 1 of every Life-With-My-Child’s-Terrible-Disability autobiography, it did reassure me quite a lot. However, it did not solve the practical problem of living with a small, determined, frustrated person who knew what he wanted but hadn’t yet figured out the niceties of letting Mummy and Daddy know. So, I reinvestigated the possibilities of sign language.

I’m getting out of chronological sync here for the purpose of narrative flow – my return to babysigning was actually a few months before that chat with the health visitor. I started it again after finding a copy of Signing Smart in the local library and mistaking it for a BSL-based guide. Since it actually turned out to be ASL yet again it was no help on the actual signs, but it proved to have some very useful information on how to get started with signing.

I realised where I’d been going wrong – I’d tried to teach Jamie signs that would be useful for me if he knew them, but, in fact, he was likely to pick it up a lot more quickly if I mixed in a few signs for things that interested him. The book suggested starting with between six and twelve signs first, evenly split between the useful and the interesting-to-baby (the authors had some slightly twee term for both these categories which currently escape me) and had several good suggestions for making the signs apparent enough to Jamie that he’d notice that Mummy was actually doing something more purposeful than just waving her hands around randomly.

So, I delved through my available resources in order to dig up sufficient signs, and finally managed to track down and get hold of a babysigning book that used BSL, and started trying to use the signs at every available opportunity and then make a few more available opportunities into the bargain, fortifying myself with glances back at the bits of the book that told me about the benefits while trying to avoid all the bits about how many benefits I could have had had I been organised enough to get going with this a lot earlier. I persevered through several long, tiresome, discouraging weeks. And, eventually, there came the day when Jamie was going into unexplained meltdown one day while Barry was taking care of him and suddenly stopped with the air of one who’s realised there’s a Better Way and, instead, raised his hand to his mouth in the ‘eat’ sign. We had communication.

Since then, Jamie’s also learnt his own versions of ‘milk’, ‘light on/off’, ‘ball’, ‘book’, ‘keys’, ‘hat’, ‘flower’, ‘more’, and ‘again’, as well as inventing his own sign for ‘music’ (clapping his hands). (Quick newsflash: Since I started writing this post, which, like most of mine, has stretched over several days worth of spare time, I can now confirm that he’s added ‘bird’ to that list.) I’m sure he could learn a lot more, but we haven’t really gone all out on it – we’ve kept it simple by sticking to the ones that seemed to come up most, and that list is further limited by our ability to find out what the signs for particular words are (I could really use signs for ‘window’, ‘balloon’, and ‘Liver Bird‘, but the authors of Let’s Sign – Early Years don’t seem to have considered those a priority). But just those few have made so much of a difference. I don’t just mean the obvious usefulness of Jamie now being able to tell us when he wants something to eat, or more of something – I mean the joy of having established a form of communication.

Of course, knowing more about what he’s thinking does have its drawbacks – having my child run to meet me at the door when I get in from work becomes just a tad less heartwarming when he signs ‘Keys’ and I realise that, actually, what he really wants isn’t me but the front door keys I’m holding in my hand. But… Today, while I was pushing him in the pushchair, he signed "Flower". It took me a moment to spot the dandelions growing by the roadside, which I hadn’t even noticed in my hurry to get to Tumbletots on time. Later on, in the supermarket, he signed "Ball". When I looked where he was looking, I realised that, indeed, the melons the woman ahead of us in the queue had unloaded onto the conveyor belt did look like balls. Even if I’d noticed them instead of just vaguely registering the existence of another shopper unloading groceries in the queue ahead, it would never have occurred to me that that was how they’d look to a toddler who didn’t know what melons were.

What I love most about signing is what I love most about motherhood – the sight of a brand new, independent little mind unfolding separately from mine, spotting different bits of the world and interpreting them differently. Signing gives me glimpses into this that I wouldn’t otherwise get. Being with Jamie is just that much more fun since we started signing.

The sleep training debate has, to no-one's great surprise, popped up again in Parentland. In the red corner, Rosa Brooks: hell, yeah, stick in those earplugs, sling 'em in the cot and let 'em howl! What harm could it possibly do? In the green corner, Hathor, the Cow Goddess Of Attachment Parenting: heresy! Don't you realise this will traumatise your child and damage his or her trust? What caring mother could ever do such a thing?

I've commented previously on my opinions on both sleep training in particular and OneTrueWayism in parenting in general, but, as it happens, what drew me into the debate this time was another favourite bugbear of mine – the spot-the-difference game between what the evidence on a contentious topic says and what people with strong opinions on the topic claim it says. What Hathor claimed, you see, is that her anti-CIO stance had been proved right by scientific research. Years of study and reams of inquiry, she assured us, all consistently maintain that it is harmful to force your child to cry it out. Indeed, Ferber himself had been proved wrong on the subject and had recanted his claims as a result.

Now, I can totally understand being anti-CIO – even its strongestproponents admit that it can be a pretty unpleasant experience for everyone concerned. I'm a lot more sceptical about the belief that it's likely to cause long-term emotional damage – personally, I think babies are a lot more resilient than some of us give them credit for, and I don't think a child who's getting plenty of affection in his life overall is going to suffer permanent trauma as a result of a few bedtimes and naptimes crying alone – but it's a big old world and there's room for a lot of different opinions out there. But claiming that there's scientific evidence for the supposed harmfulness of CIO – well, that's where things leave the realm of opinion and get into the realm of ascertainable fact. Or, as it may be, fiction.

I've spent a lot of time looking at what different parenting forums and websites have to say about CIO, including a lot of the CIO-is-the-work-of-the-devil sites, and I've often come across this claim before. Invariably, the 'evidence' presented (when the person making the claim actually does present any evidence instead of just assuming that the existence of evidence is so obvious as to need no further comment) falls into one or more of three categories:

1. Opinion.

2. Anecdote (often of cases where a number of other things were changed in a child's life at the same time. "This two-month-old baby was left to cry herself to sleep and her parents stopped spending as much time with her during the day and she was fed less often and, guess what, she didn't thrive. Obviously the sleep training!")

3. Actual research that isn't actually into CIO. There is a huge amountof research out there to show that regular positive attention and affection is crucially important for children's emotional development, and one of the few issues in parenting that just about anyone with any glimmer of a clue can actually agree on is that prolonged, regular neglect during childhood is liable to cause children problems; sometimes huge problems. However, sleep training isn't prolonged, regular neglect. It involves leaving children for short periods at specific times, while giving them just as much loving care as normal at other times (possibly more, since responding lovingly and affectionately to another person tends to be rather easier if you're not going insane with sleep deprivation). Pointing to studies on the desperate harm suffered by Romanian orphans left abandoned in their cribs all day and every day as evidence of what a Bad Thing sleep training is is about as valid as pointing to studies on starving, malnourished children in the Third World and using them as support for a claim that you're doing your child terrible damage by expecting her to wait an extra twenty minutes for her dinner now and again.

Since no-one from the anti-CIO-for-sleep-training brigade ever seemed to cite any actual studies on the use of CIO for sleep training, I searched Medline to whether any such studies had ever actually been done. (The technical term is "extinction", if you want to do the same thing.) There are no long-term studies that I could find, but I did find twostudies that looked at the psychological status of children shortly after sleep training. Both of these seem to have passed unnoticed by the very people who are supposedly most fascinated by the psychological status of children following sleep training. Call me cynical, but am I wrong in thinking that this might possibly have something to do with the fact that both studies actually showed children to be, if anything, somewhat more secure following CIO?

So, I replied to Hathor's claim with a quick summary of the above. Since the list of references she gave in reply was fairly typical of the kind of stuff that gets presented as evidence in these debates, I'll go through them.

One reference to a speech by James McKenna in which he cited primate studies into short-term mother-infant separation. Now, I can't comment directly on how these studies might or might not relate to CIO, because direct references weren't given in Hathor's quote or anywhere else on the 'Net that I could find. However, a Medline search on "mother-infant separation" shows that, while lengthy separations do indeed appear to be harmful to infants, infants separated from their mothers for brief periods of time only were actually less fazed by separation when older than primates who hadn't undergone such separations.

One newspaper article about Margot Sunderland's new book, The Science Of Parenting. I haven't read the whole book, as yet, but I've read the section on sleep training. No references to studies on CIO.

Twoarticles about the infamous Commons and Miller paper. I call it infamous because it gets mentioned in tones of reverence all the time in CIO debates. It is, according to popular legend about it, a study by two Harvard psychiatrists that showed CIO to be harmful. The only part of that that's correct is that the authors do indeed work at Harvard.

The Commons and Miller paper wasn't a study and wasn't about CIO. (And the authors are psychologists, not psychiatrists.) It was a discussion of the many ways in which child-rearing practices differ in two different societies (the USA and the Gusii tribe of Kenya) and what kind of long-term effects this might have on children reared in the two societies. It's a fascinating paper, but it isn't a study.

One reference to a study stating that all of 186 hunter-gatherer societies looked at in one study practiced co-sleeping. Which tells us, um, precisely zero about the effects of CIO.

One webpage on the general evils of leaving babies to cry, devoid of any actual references.

And one article about a study showing that infant rats who received plenty of affection from their mothers were more secure than infant rats who received little maternal attention. Which, as I discussed above, adds to the already sizeable body of evidence that giving your child little attention overall is A Bad Thing, but tells us nothing about the effects of a specific short-term intervention such as CIO.

My dissent on the issue of whether this constituted adequate evidence of the evils of CIO caused, as you can imagine, somedebate. Since there are now quite a number of questions for me in the second comment thread still awaiting a reply, I decided to move the discussion over here and answer them in this post.

What exactly are you looking for for something to be a study?

Well, not wanting to sound tautologous or anything, but a study involves studying something. When someone says that CIO is harmful but doesn‘t actually provide any evidence to back this up, that’s an opinion. When someone speculates on whether CIO may be harmful, that’s a theory. When someone makes an attempt to assess the state of children following CIO, that’s a study. (Whether or not it’s a good study is, of course, a whole separate and important question.)

Or to have compelling information for you to see that CIO is not a good thing for babies?

I’m not trying to claim it’s a “good thing” (although I believe that, for some babies, it’s a better thing than the alternative). I’m objecting to the claim that research has proved it to be a harmful thing. But, to answer your question: if well-conducted studies into the psychological state of children following sleep training showed them to be psychologically worse off after CIO, then that would be compelling evidence.

If I may be so bold as to ask, what exactly are you doing on a site that is pro co-sleeping trying to defend CIO?

Objecting to misinformation. I don’t object to people being anti-CIO; I do object to people claiming the evidence states something that it doesn’t.

Or at least trying to say that there needs to be studies to prove that co-sleeping is benificial (sic)?

I haven’t said that.

I guess it all comes down to doing what works best for your family, taking into consideration that babies/children are people too, and that they have needs that they can not meet themselves do to their age.

Doing what works best for your family is exactly my philosophy, as well. However, my experience is that when that statement is followed by that sort of qualifier in this sort of debate, what it actually means is that you don’t believe CIO is ever going to be what works best for anyone's family. And, having read a lot of different stories from different people with different experiences, I can’t agree with that.

There are may ways to help a child learn to sleep that do not involve them having to cry for extended periods of time.

And I’d like to see them muchmorewidelyknown (by which I do not just mean the blanket “Co-sleeping will solve all your problems! What more could you possibly need to know?” recommendation that seems to be all that some attachment parenting advocates have to offer). I’d also, however, like to see it more widely recognised that – like everything else in parenting – theyaren’t universal solutions that work for all children and all families.

But I think we need to remember that there are a lot of parents out there who might well have tried alternative solutions to sleep problems with their children if they’d known about them, but who didn’t know about them and thus tried some form of CIO. Now, leaving these families thinking “Damn, if only I’d known about that at the time! Could have saved us an unpleasant few evenings” is one thing; leaving them thinking “Oh, no! There’s scientific evidence that the way I handled things was actually damaging for my child!“ is another. If we’re going to do that to parents, we ought to be damn sure we have our facts straight first. If there isn’t any actual evidence that CIO is harmful then we shouldn‘t be claiming that there is, no matter how vehement our personal opinions on the subject.

Touche on the Harvard study, I haven’t seen the actual paper the article was based on.

But a comparative multi-disciplinary investigation of different societies is not necessarily less valid than lab-controlled experiments. It’s what anthropologists do.

It's a valid research method for some things, although I don't think it would be a good way of studying CIO – there are so many differences between different societies that it wouldn't be possible to single out one specific brief episode during childhood and pinpoint the effects of that. However, the objection I was making is not that their paper is an anthropological study, but that it isn't a study at all. It's a discussion of previous research into the topic, and it doesn't contain any actual information on how the different methods of child-rearing affect children. It simply theorises on how the differences might affect children, and suggests this as a topic for further research.

These [the children in the first CIO study] are 6-24 month old children they studied. How would you guess they rated the security and anxiety of these children?

They used a modified version of a scale called the Flint Infant Security Scale, filled in by the parents. The second study I cited used the same scale, and also visual analogue scales to measure the parents' impressions of how depressed and how anxious/insecure their children seemed.

I personally can’t see how being left alone to sleep can make anyone more secure.

I've found that dealing successfully with a situation I originally thought to be beyond me usually leaves me feeling more secure. Knowing that I can deal with it leaves me with more confidence in my own abilities.

It's also worth remembering that children who have difficulty getting to sleep and wake frequently in the night are often sleep-deprived themselves. If adults find it easier to cope with life's stresses when well-rested, why shouldn't the same be true of children?

To me this abstract is pretty unconvincing.

That's fine. I'm not out to bang a CIO-is-wonderful drum here – that isn't the way I feel at all. What I'm trying to point out is that the existing evidence doesn't show it to be harmful.

I don’t believe in CIO. Sarah, you obviously do to some extent

What I believe in is finding solutions that work for individual families, individual children. I believe that sometimes, that solution is going to be CIO. And I believe that though another method could potentially have worked just as well or better in most (not all) cases where CIO is used, that doesn't mean that using CIO in those cases was actually harmful.

Anyway, people also used to widely believe in ’spare the rod spoil the child’ and were full of evidence of how spanking led to better children.

And stories like that don't tell you that we should be extremely careful about not claiming that the evidence supports a particular way of doing things purely because that's what it suits us to believe?

I just don’t see how a three or six month old baby for example can know the difference between just having been left in his safe nursery and having been abandoned completely.

Well, when his mother turns up again, I think he's going to figure out that it was the former.

And how do you really know that a three month old really isn’t hungry, or that something isn’t really bothering him?

In fact, I don't know any experts who advocate using sleep training for a baby as young as three months. But, assuming that you didn't feel that to be the crucial point of your question: By knowing your child and by using common sense. For example, if you've just nursed your child and he isn't taking any more milk then it's a fair bet that hunger isn't the problem.

And besides that, why are only physical needs valid when speaking about babies? Certainly judging by the numbers of relationship gurus out there, all the books, all the Dr. Phils and beyond, we in North America believe that we have emotional needs that deserve to be met.

Certainly. But that doesn't mean that someone has to be available to meet them every minute throughout the day and night. I don't expect my partner to drop absolutely everything he's doing to talk to me whenever the fancy takes me, even if it's 4 a.m. and he's in a sound sleep. I know that he has other things to do that are important; and I know that that doesn't detract from his love for me or his ability to be supportive and available to me overall.

Why is it less valid for a baby to be lonely than it is for an adult to be lonely?

It isn't. But, similarly, why should it be so much more valid? If a friend staying with you was regularly expecting you to come and keep her company regardless of what hour of the day and night it was or what else you might need to do, how long would it be before you started saying no some of the time?

I mean no offense by this, but I don’t really need you to answer these questions. I know what the answers are for me.

Which is good. The point at which I start having a problem with these sorts of discussions is when people start deciding that they know what the answers are for everybody else.

I think ultimately all there is to this topic is to follow your heart, as Julinda and Serendipity said above.

And if yourheartleadsyou to the conclusion that CIO is the right answer for your baby?

I hope these articles make people think about this issue a little bit more, to reconsider, to tune into their heart and see what is right for *them*.

I'd love it if there were more articles that did that, but I don't think either Rosa Brooks' or Hathor's had that aim. What Hathor, like Brooks, really wants other people to do is to tune into her heart and do things the way she thinks is right. That's the problem I have with this issue, as with so much else in parenting; so many people think they've got the one right way that's going to work for all children, just as though children weren't individuals as much as the rest of us.

But that's not why I wrote the reply I did to Hathor's post. I replied to it because I believe that she was not correct in claiming that the existing scientific evidence proves CIO to be harmful. And I hope I'd have had the guts to say so even if I was passionately anti-CIO on a personal level. Judging the evidence on the basis of what we want it to show is a temptation that's impossible to avoid altogether – but we should be willing to be as honest as we can be about what it actually shows.

(I don’t know whether or not I’ll leave this article up permanently, as it has more identifying information in it than I’ll usually put on the blog; but, right now, I’m going to post it.)

A London coalition of societies working for the homeless have set up a new award, for innovation in dealing with the problem of homelessness. They’ve named it after a past chairman of their group who, sadly, died a few years back, but whom they wished to honour for his work and achievements for their group. Michael Whippman. My father.

The award ceremony was on Tuesday night. I got dolled up in my posh frock (surprising my son, who, even at the age of nineteen months, has apparently worked out that Mummy doesn’t do the posh frock thing), and my mother and I headed into Central London and met my sister at Sadler’s Wells for a buffet and drinks and speeches and displays about the winners and the runners-up, and street art for entertainment (oh, well, you can’t have everything).

One of the people who’d worked with my father made a speech about him. He used to be quite intimidated by Michael Whippman, he said, when he first got to know him. Michael’s sheer incisive brilliance and his way of calmly cutting through everything extraneous at meetings and making sure everyone stuck to whatever the point was and actually got things done – these traits could be somewhat nerve-wracking to the people who worked with him, until they got to know the dry wit and the sheer gentleness that tempered them. I grew up knowing the wit and the gentleness, and, although I can see that from a different perspective working with that kind of intelligence could be intimidating, those were never the eyes through which I saw my father. To me, he’ll always be the man who told us stories about a little girl and her talking teddy bear and an amazingly surreal cast of peripheral characters including a dancing ant and a large vat of green slime.

The people who win the Michael Whippman prize in the years and decades to come won’t know any of these sides of him, of course. To them, Michael Whippman will just be a name, and the only meaning it will have to them is the honour of the prize. And that’s a pretty damn good meaning for it to have. People who never knew my father or anything about him will associate his name with innovation and with receiving a high honour. For this, and for so much else, I’m prouder of my father than I can say.

Hang onto your hats – we may have to start getting technical at this point. If I’m going too fast, just wave your arms at me and yell loudly, or something.

The article does raise some crucial points about the difficulties with research into breastfeeding. As they point out, it is not possible (for obvious ethical reasons) to conduct the gold standard of research – a trial in which mothers are assigned by the toss of a coin or equivalent procedure into breastfeeding or non-breastfeeding groups. (One point that I must make here, to soothe my pedantic little soul – this type of trial would be a randomised controlled trial, not, as they called it, a ‘case-controlled study’. A case-control study is something completely different. While it doesn’t ultimately make a difference to the point they were making, I did find it bizarre that two statistics professors could make such an elementary mistake.)

Non-randomised studies have a flaw in them from the start – they’re subject to what we call confounding factors. Mothers and babies who breastfed are likely to differ in other crucial ways from mothers and babies who didn’t. Women who choose to breastfeed may well be making other choices about their parenting that differ from those of women who choose to formula-feed; women who are unable to breastfeed or to continue breastfeeding may have been rendered unable by some factor that, in itself, is relevant to the baby’s health. This makes it difficult to know to what extent the differences found between breastfed and non-breastfed babies are due to the breastfeeding itself, and to what extent they’re due to factors that tend, in practice, to be associated more with breastfeeding than with formula feeding or vice versa.

There are statistical ways to take confounding factors into account in a study analysis and hence cancel out their effect on the end results, and any good-quality research will do this as far as possible. The problem, however, is that we can only do that for confounders that we know of and can collect data on. This is a potential source of bias in any non-randomised study. It’s an inevitable flaw in breastfeeding research, and STATS.org are quite right to point it out.

However, using this problem as a reason to be appropriately cautious about interpretation of results is one thing; using it selectively as an excuse to reject only the research whose results you don’t like is another. I’ve previously mentioned one of our most deep-rooted sources of bias; our tendency to reserve our criticisms of study design only for studies whose conclusions we don’t like. This article was, as it happened, the perfect example. Smoking can no more be randomised than breastfeeding can, and hence all our existing research into the harms of smoking in humans is based on non-randomised studies. But STATS.org’s criticism of the research into breastfeeding (which they ultimately dismiss as "voodoo science") stands in stark contrast to their unquestioning acceptance of the research showing that smoking during pregnancy is harmful.

Please don’t misunderstand this: I am not saying that smoking during pregnancy is harmless. Quite the reverse. I am saying that in spite of the flaws inherent in non-randomised studies, we have no problem saying that the research on smoking and pregnancy is sufficient for us to accept a harmful effect. We don’t dismiss that evidence out of hand simply because the studies aren’t perfect; and, similarly, we are not justified in simply dismissing the huge number of studies that show beneficial effects from breastfeeding.

A far more realistic and constructive approach would be to consider what criteria a good-quality study should fit, pick out the studies that met those criteria, and consider the strengths and weaknesses of the evidence overall. An article aimed at doing that could have been both useful and fascinating. (Writing it is on my list of things to do in that mysterious alternative universe I keep hoping to stumble into where I actually get large amounts of spare time.) Goldin, Smyth and Foulkes, however, simply seem to have picked out a few studies they could pick at and acted as though these were representative of the body of research generally.

For example, the article’s conclusion that the benefits of breastfeeding are limited to ‘certain kinds of low-risk infections’ seem to be based largely on analysis of a single study. Not only was the study in question fairly small, but, from the STATS.org description of it, it seems the two groups being compared could be roughly described, not as "ever breastfed" and "never breastfed", but as "sometimes breastfed, quite a lot of formula" and "sometimes formula-fed, quite a lot of breastfeeding". This is a design flaw that is automatically going to cause the study to underestimate any breastfeeding benefits, because the effect is going to be so diluted by the overlap between the groups. In view of these problems, it’s telling that this study came up with any benefits for breastfeeding – we really can’t deduce much from the fact that the benefits it found were limited. STATS.org, however, seem to be taking it as the final word on the matter.

Now, the AAP position paper on breastfeeding from which STATS.org takes this reference cites – by my count – sixty-eight references for studies showing possible short-term or long-term benefits for breastfed babies (plus fourteen references to potential benefts for the mother). STATS.org single out a grand total of five of these for specific discussion (if we count the passing mention of the studies on breastfeeding and diabetes as ‘discussion’). So, out of all those dozens of studies, why did STATS.org place so much weight on one that seems so likely to underestimate benefits of breastfeeding?

The only reason we’re given why this particular study is singled out for mention is that it is, supposedly, an example of one of many studies that, according to STATS.org, "simply didn’t find what AAP claimed they did". In other words, STATS.org claim that AAP are making incorrect claims about study findings. A serious accusation indeed.

Except that it doesn’t seem to be true. Or, at any rate, the authors totally fail to produce any evidence to support it. They claim that the lack of difference of rates of respiratory infection in the study "contradicts the AAP’s claim that there were decreased upper and lower-respiratory illnesses for nursed babies". But the AAP didn’t claim that this particular study showed a difference in rates of respiratory infection. They say that it showed a difference in rates of diarrhoea – which it does indeed. (They cited nine studies as reference for their claim that rates of respiratory tract infection are decreased. Goldin, Smyth and Foulkes discuss none of these.)

Are the authors deliberately lying, or are they just very sloppy about checking details? Either way, it doesn’t say much for their reliability. We are given no details on the other supposed studies that "simply didn’t say what the AAP claimed they did", so I couldn’t assess whether there was any truth to this claim at all. However, this mistake on the part of STATS.org doesn’t bode well.

What did STATS.org tell us about the other studies it discussed? The most important was the Chen and Rogan study on which the AAP base their claim of reduced mortality in breastfed babies. STATS.org dismiss this on the grounds that the study showed that breastfed infants were less likely to die of injuries. True, but certainly not the whole truth.

There’s another statistical concept that needs explaining briefly here – the idea of statistical significance. Simply put, statistical significance is the likelihood that any findings in a study are down to something more than just coincidence. It’s normal to get small differences between the outcomes in two groups purely by chance, just as it’s normal to get 501 heads rather than 500 if you flip a coin a thousand times. But if a thousand coin flips come up with 600 heads, there’s probably something about the coin that’s giving you that result; and, similarly, the larger the differences in outcomes between two groups that differ only in the factor you’re studying, the larger the likelihood that the differences in outcomes are genuinely due to differences in that factor rather than to sheer coincidence. By convention, once the chances of getting a particular result by sheer chance are less than one in twenty then that result is held to be ‘statistically significant’.

The difference in size between two outcomes necessary for the result to be statistically significant depends, among other things, on the frequency of the outcomes. With small groups, a tiny difference between the numbers is less statistically significant than it would be with big groups. (If you flip a coin 1000 times and get 600 heads, there’s probably something odd about the coin – if you flip a coin 10 times and get 6 heads, there’s nothing particularly significant about that, even though the proportion of heads is the same in each case.) Hence, when you’re studying an outcome that’s as rare as infant death in the USA fortunately is, a difference between the figures in two groups has to be quite a sizeable percentage of the overall numbers in order to show up as statistically significant. The more you split the groups down into sub-groups, the less likely it is that even a genuine difference will achieve statistical significance, because there just won’t be the numbers for it to do so.

This, as far as I can tell, is what seems to have happened in the Chen and Rogan study. The author looked at death rates across the board (the only causes excluded from their analysis were cancers and congenital birth defects). Death rates were down overall and in each subgroup studied. However, when the deaths were divided into separate groups, although each group showed a reduction in death rates, the groups of babies dying from infections, SIDS, or other causes were too small for a small difference to show up as statistically significant. It’s only when you combine all the deaths from all causes that you get a group large enough for the statistical significance to show up.

Now, this study is certainly not without flaw (something the authors themselves freely acknowledge). And it’s also worth noticing that even if the 21% reduction in death rates is the true figure and not due to some confounding factor for which the authors couldn’t adjust, that equates to an extremely small risk for any individual formula-fed infant – that level of risk would mean that for every fifty thousand children not breastfed, nine would die as a result. But looking at the results realistically is one thing; dismissing them on spurious grounds because they don’t happen to suit you is another thing entirely, especially when other studies have come up with similar evidence. (STATS.org tell us that the reduced rates of SIDS in this study weren’t statistically significant; what they don’t mention are the otherstudies cited by the AAP that show a possible link.)

The only other three studies about which STATS.org had anything to say were the three pointing towards a possible association between breastfeeding and decreased risk of diabetes. Two of these were apparently dismissed on the grounds of being based on Chilean and Pima Indian children respectively (why this should be grounds for ignoring them was not explained). The third study, the authors claim, "only found results for children exposed to food. Infant formula wasn’t even considered!" Which is most peculiar, because when I checked out the abstract it certainly mentioned finding an association between diabetes and early cow’s milk exposure (in babies who were already at high risk of diabetes), and cow’s milk was a major ingredient of formula last time I checked.

Of course, although STATS.org are incorrect in saying that no benefit has hitherto been shown of breastfeeding as far as diabetes prevention goes, it’s true that the evidence so far is still in the early and tentative stages. But the AAP’s paper doesn’t try to claim otherwise – diabetes was one of the conditions listed in the section that specified "Some studies suggest decreased rates… Additional research in this area is warranted." So, again – why did the authors single out this particular topic for further discussion, when several important risks for which the AAP do claim strong evidence of benefit from breastfeeding (meningitis, sepsis, necrotising enterocolitis) were ignored?

Because, it seems, this was their chance to get in a swipe at the NYT. "The Times takes the concept that an indictment is as good as a conviction to new heights" trumpet the authors, under the subheading "Baseless reporting". What they conveniently omitted to mention was that the Times did actually specify that there wasn’t enough evidence to prove a link. I don’t know whether STATS.org are bashing the NYT solely in order to discredit what they have to say about breastfeeding, or whether it’s actually the other way round and they have some grudge against the NYT which is colouring their interpretation of subjects on which the NYT report. What I do know is that by this stage it was clear that, whatever the authors pretended, they weren’t even attempting to look at the NYT article impartially.

They use the same technique of telling only part of the truth in order to pooh-pooh the AAP’s conclusions about the economic benefits of breastfeeding. The AAP, they say, "is not officially in the business of making economic calculations" (side note: is that true? As an employee of the National Health Service, I’m intrigued by the idea of a country in which a major medical body can get away without being in the business of making economic calculations), and their arguments about the economic benefits "are simply bad (social) science, and are fed by conviction or opportunism rather than hard evidence". But what they fail to mention is that the AAP aren’t simply making it up as they go along; they cite four studies and two economic analyses (which appear, from the government think-tanks mentioned in the article, to have been done by people who are officially in the business of making economic calculations) as evidence for their claims. (One of the studies was a comparison of breastfeeding and formula-feeding among employed mothers, making a nonsense of STATS.org’s claim that economic benefits would be cancelled out by the incompatibility of breastfeeding and full-time employment.)

So, the authors conclude, what should we take away from this? Their "inescapable conclusion" is, apparently, that it is "nothing short of irresponsible" for a public health campaign to have compared not breastfeeding to smoking during pregnancy. (This was, apparently, their biggest concern with the whole NYT article; I was somewhat amused that it was that, rather than the comparison with riding a mechanical bull during pregnancy, that apparently struck them as shockingly inappropriate.)

They also make one rather good point in their conclusion; namely, that we take risks every day, with our children as well as ourselves (crossed a road with your child recently?), and that it’s quite normal to accept a certain amount of risk if you feel the benefits are worthwhile. But to make these sorts of choices, we need accurate information about what the risks and benefits actually are. On the subject of choosing not to breastfeed, STATS.org mislead us sadly, and to an extent that can only be deliberate, about both.